Exam 1- NMS General Info Flashcards
What can static palpation find?
Structural abnormalities, landmarks, soft tissue path
What can motion palpation find
Fixation (restriction)
Also ligament laxity from excessive joint play
Muscle test scale ranges from..?
0-5
Name the Muscle test rating:
No muscle movement, no joint movement (paralysis)
0/5
Name the Muscle test rating:
Full range of motion but not against gravity
2/5
Name the Muscle test rating:
Full range of motion against some resistance
4/5
Name the Muscle test rating:
Visible muscle movement, but no joint movement (twitch)
1/5
Name the Muscle test rating:
Full range of motion against full resistance
5/5
Name the Muscle test rating:
Full range of motion against gravity, but not against resistance
3/5
DTR Scale goes to..?
0-5+
Name the DTR Grading scale…
Hyperactive without clonus (hyper-reflexive)
3+
Name the DTR Grading scale…
Hypoactive reflex (hypo-reflexive)
1+
Name the DTR Grading scale…
Hyperactive w/ sustain clonus
5+
Name the DTR Grading scale…
Absent reflex
0
Name the DTR Grading scale…
Hyperactive w/ intermittent clonus
4+
Name the DTR Grading scale…
Normal “equal bilateral” reflex
2+
What is clonus??
A form of movement marked by contractions and relaxations of a muscle, occurring in rapid succession seen with, among other conditions, spasticity and some seizure disorders.
Sensory (dermatome) grading scale…
Absent sensation
Anesthesia
Sensory (dermatome) grading scale…
Equal sensation bilaterally
Normal
Sensory (dermatome) grading scale…
Decrease sensation
Hypoesthesia AKA Hypesthesia
Sensory (dermatome) grading scale…
Increase sensation
Hyperesthesia
Exam technique for CN I (olfactory)
Testing 1 nostril at a time, use non-irritating stimulant. Pt should be able to smell each side
Cloves ideal- can use soap, toothpaste or perfume
Unilateral loss of smell in CN I testing could mean what?
More likely significant- may Imply a structural brain lesion affecting the olfactory bulb or tract.
Could also be due to local causes (deviated septum, or blocked nasal passage)
Bilateral loss in CN I testing could imply what?
Rhinitis
Or damage to cribiform plate
CN II (optic nerve) exam technique for visual acuity
Each eye tested separately
Test best corrected vision using eyeglasses
Any pt with uncorrected visual acuity of less than 20/20 should be examined w/ a pinhole. Improvement of vision through a pinhole indicated that the error is refractive
Test distant vision using a snellen chart at 10 or 20 feet
How do you check peripheral visual field when testing CN II?
Wiggling fingers
Counting fingers
White pin
How do you test central visual field when testing CN II?
Red pin
Exam technique for CN II visual fields
Assessed by confrontation, i.e the examiner compares the pts visual field to their own and assumes that theirs is normal
1st test each eye separately
Test both eyes together w/ wiggling fingers
Review slides 14 and 15 for test
Slides 14 and 15
The normal monocular visual field extends approx _____ degrees laterally
___ degrees medially
___ degrees superiorly
____ degrees inferiorly.
It is divided into _______ and ____ halves and _____ and ____ halves.
100
60
60
75
Nasal and temporal
Superior and inferior altitudinal
A blind spot is located ____ degrees ____ to fixation and just below the:
15
Temporal
Horizontal meridian
Light entering the eye travels along the ____ nerve to the ____ region of the _____ to cause pupillary constriction through the ____ ____ and ___ ____ nerve components of the _____ ____ nerve.
Optic
Pretectal
Midbrain
Visceral motor
Short ciliary
Ocular motor
Exam technique for CN II- pupillary light reflex/eyelid elevation
Observe for ptosis
Observer pupils for size
Observe for any irregularities or asymmetry
Review slide 19 and 20 for CN II Pupillary light
Slide 19 and 20
Abnormal response for CN II pupillary light reflex/eyelid elevations
Ptosis is present
If eyelid covers part of all of the pupil when looking directly ahead
CN III (oculomotor), IV (trochlear) and VI (abducens)
Extraocular movement exam technique
Examiner places themselves approx 1 meter in front of the pt
Ask pt to look each side, up and down following an H pattern
Pursuit: ask pt to follow a target (finger or pen) with eyes w/out moving their head
Pause at ends of gaze to observe for nystagmus
How would you assess for saccadic eye movements
Have the pt make quick horizontal and vertical eye movements
How is optokinetic nystagmus performed
By having the pt follow a series of moving horizontal/vertical stripes and observing for nystagmus
How to test light touch for CN V
Light tough with a cotton wisp
If pt complains of sensory symptoms, it is advisable to perform side to side comparisons moving from the impaired side to the normal side
CN V Trigeminal light touch examination technique
Touch a cotton wisp to forehead, cheek and chin
Use the pin to test for pain and tuning fork to test for cold
The corneal reflex allows what?
An objective assessment of facial sensation.
Afferent Limb is V1 of the trigeminal nerve
Review slide 27 and 28 for exam technique of corneal reflex and pain and them . Too much to types
Slide 27 and 28
What does the mental status exam test?
State of consciousness
Orientation
Ability to cooperate
Mood
Thought process
Memory for recent and remote events
Ability to handle concepts and proverbs
Practical skills
Speech problems and recognition of aphasia
Components of the sensory exam
Dorsal column systems
Lateral spinothalamic tract
Ventral spinothalamic tract
Spinocerebellar tract
Double simultaneous stimuli (extinction)
The dorsal column systems consists of:
Fasciculus gracilis and cuneatus
Function of the dorsal column systems
Fine touch (graphesthesia and stereognosis)
Vibration sense
2 point discrimination
Function of lateral spinothalamic tract
Pain and temp
Function of ventral spinothalamic tract
Pressure and crude touch
Function of spinocerebellar tract
Coordination
Sensory exam technique
Begin distally and move proximally- avoid calloused area
Compare rt-lt
Assess for a sensory level, peripheral nerve or dermatomal sensory impairment
Dorsal column (light touch) exam technique
Use a cotton wisp
Apply gentle touch
Ask pt to close eyes and report “yes” every time they perceive the stimulus
Pain (lateral spinothalamic tract) exam technique
Use disposable pin
Ask pt to Close their eyes and report whether they feel sharp or dull
Apply the short stimulus to all sites since if only the dull stimulus is applied, pain sensation has not been assessed.
Temperature (lateral spinothalamic tract_ exam technique
Use cold vibration fork
Ask pt if the perceive fork as cold.
Vibration sense exam technique
Use 128 hertz vibration fork
Apply stimulus over distal phalanx of index finger or large toe
Ask pt to report whether they feel vibration sense and then to report when it stops in order to assess the minimal threshold to perceive the stimulus.
Compare to your own extremities
Position sense exam technique
Demonstrate to the pt initially w/ eyes open that you will be moving their digit up or down
Ask pt to close eyes
Stabilize distal interphalangeal joint of the upper extremity and make minimal movements upwards or downwards and ask pt to report after each movement the direction.
Similarly in lower extremities, stabilize the interphalangeal joint and move large toe up or down.
Coordination (spinocerebellar tract) exam technique — upper extremities
Finger to nose
Rapid index to thumb movements or individual digits to thumb, rapid small index finger sircles over the opposite dorsal webspace, rapidly alternate each hand palmer then dorsal aspect down over thigh or opposite hand
Coordination (spinocerebellar tract) exam tech for lower extremities
Ask pt to place their heel on their opposite knee and slide their heel down shin to ankle
Ask pt to tap their opposite knee with their heel
Have pt reach for your finger w their large toe
Ask pt to perform rapid foot taps
What test is this?
Have pt flex their shoulder to 45 degrees and elbow to 90 degrees and make a fist. Then grab the fist and try to extend the elbow while the pt resists. Let go and see if the pr can stop from hitting themselves.
Steward Holmes rebound test
2 point discrimination exam tech
Use either calipers or a opened paper clip w/ 2 parallel ends
Demonstrate to the pt w/ eyes open by applying either 1 or 2 points of the stimulus to the fingerpad
Ask pt to close their eyes
Deliver stimulus and ask pt to report if they feel 1 or 2 points
Normal response of 2 pt discrimination?
Normal values over fingerpads are 2-4 mm
Which exam technique is this?
Drawing something in the pts palm with your finger— a number, for ex.
Ask pt to close their eyes and identify it
Graphesthesia
What is tested with this exam:
Place an item in the pts hand w/ their eyes closed. Ask them to feel it and identify it.
(Use coins, a key, safety pin, paper clips, etc)
Stereognosis
What does Romberg’s test test?
Eyes
Ears
Dorsal Column
(Tests all 3 when eyes are open. When closed, only tests ears and DC)
What test is this?
Pt stands in anatomical position with legs tight together with eyes closed.
Should be able to maintain balance
Romberg’s test
Extinction (double simultaneous stimuli) exam technique - Tactile (sensory)
w/ eyes closed, touch pt on left side, right side, or both. Have pt report which side they feel it on.
should only be done if the pt can perceive a unilateral stimulus
Visual extinction exam:
Wiggle a finger to the left, right, or both visual fields an ask the pt to report where they see it
Auditory extinction test
Snap fingers on the left, right or both sides and have pt report where they hear the stimulus
When testing for extinction, it is important to deliver bilateral stimuli simultaneously w/ no time lag in between
What test is this:
Use sharp edge of reflex hammer and stroke the bottom of the pt’s foot frmo heel up the lateral foot to the little toe across the ball of the foot to the big tow
Babinski’s sign
What does babinski’s sign test for
Upper motor neuron lesion
Normal response to babinski:
Abnormal response:
Normal- toe flexion or no response
Abnormal- big toe extension, other digits abduction
What test is this:
Flick the nail on the 3rd or 4th finger. A positive response is seen in flexion of terminal phalanx of the thumb
Hoffman’s sign
What does Hoffman’s sign test for
Problems in the corticospinal tract
